|
JAGWIRE GUIDEWIRE STR .025 260CM M00556461
|
Facility
|
OP
|
$1,712.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3211486
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$498.53 |
| Max. Negotiated Rate |
$1,638.04 |
| Rate for Payer: Aetna Commercial |
$1,602.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,531.21
|
| Rate for Payer: Aetna Managed Medicare |
$498.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,157.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$890.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$854.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$943.65
|
| Rate for Payer: Cash Price |
$513.60
|
| Rate for Payer: Cigna Commercial |
$1,638.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$996.38
|
| Rate for Payer: Health EOS Commercial |
$1,584.63
|
| Rate for Payer: HFN Commercial |
$1,638.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,335.36
|
| Rate for Payer: Multiplan Commercial |
$1,424.38
|
| Rate for Payer: NAPHCARE Commercial |
$1,068.29
|
| Rate for Payer: Preferred Network Access Commercial |
$1,638.04
|
| Rate for Payer: Quartz Beloit One Network |
$872.44
|
| Rate for Payer: Quartz Commercial |
$1,157.31
|
| Rate for Payer: Quartz Medicare Advantage |
$1,068.29
|
| Rate for Payer: The Alliance Commercial |
$890.24
|
| Rate for Payer: WEA Trust Commercial |
$979.26
|
| Rate for Payer: WPS Commercial |
$1,318.75
|
|
|
JAGWIRE GUIDEWIRE STR .025 260CM M00556461
|
Facility
|
IP
|
$1,712.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3211486
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$872.44 |
| Max. Negotiated Rate |
$1,638.04 |
| Rate for Payer: Aetna Commercial |
$1,602.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,531.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$943.65
|
| Rate for Payer: Cash Price |
$513.60
|
| Rate for Payer: Cigna Commercial |
$1,638.04
|
| Rate for Payer: Health EOS Commercial |
$1,584.63
|
| Rate for Payer: HFN Commercial |
$1,638.04
|
| Rate for Payer: Multiplan Commercial |
$1,424.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,638.04
|
| Rate for Payer: Quartz Beloit One Network |
$872.44
|
| Rate for Payer: Quartz Commercial |
$1,068.29
|
| Rate for Payer: WEA Trust Commercial |
$979.26
|
| Rate for Payer: WPS Commercial |
$1,318.75
|
|
|
JAGWIRE GUIDEWIRE STR .025 450CM M00556561
|
Facility
|
OP
|
$1,712.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2973105
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$498.53 |
| Max. Negotiated Rate |
$1,638.04 |
| Rate for Payer: Aetna Commercial |
$1,602.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,531.21
|
| Rate for Payer: Aetna Managed Medicare |
$498.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,157.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$890.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$854.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$943.65
|
| Rate for Payer: Cash Price |
$513.60
|
| Rate for Payer: Cigna Commercial |
$1,638.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$996.38
|
| Rate for Payer: Health EOS Commercial |
$1,584.63
|
| Rate for Payer: HFN Commercial |
$1,638.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,335.36
|
| Rate for Payer: Multiplan Commercial |
$1,424.38
|
| Rate for Payer: NAPHCARE Commercial |
$1,068.29
|
| Rate for Payer: Preferred Network Access Commercial |
$1,638.04
|
| Rate for Payer: Quartz Beloit One Network |
$872.44
|
| Rate for Payer: Quartz Commercial |
$1,157.31
|
| Rate for Payer: Quartz Medicare Advantage |
$1,068.29
|
| Rate for Payer: The Alliance Commercial |
$890.24
|
| Rate for Payer: WEA Trust Commercial |
$979.26
|
| Rate for Payer: WPS Commercial |
$1,318.75
|
|
|
JAGWIRE GUIDEWIRE STR .025 450CM M00556561
|
Facility
|
IP
|
$1,712.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2973105
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$872.44 |
| Max. Negotiated Rate |
$1,638.04 |
| Rate for Payer: Aetna Commercial |
$1,602.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,531.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$943.65
|
| Rate for Payer: Cash Price |
$513.60
|
| Rate for Payer: Cigna Commercial |
$1,638.04
|
| Rate for Payer: Health EOS Commercial |
$1,584.63
|
| Rate for Payer: HFN Commercial |
$1,638.04
|
| Rate for Payer: Multiplan Commercial |
$1,424.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,638.04
|
| Rate for Payer: Quartz Beloit One Network |
$872.44
|
| Rate for Payer: Quartz Commercial |
$1,068.29
|
| Rate for Payer: WEA Trust Commercial |
$979.26
|
| Rate for Payer: WPS Commercial |
$1,318.75
|
|
|
JAK2 Exon 12 Mutations
|
Facility
|
IP
|
$285.00
|
|
| Hospital Charge Code |
2942930
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$145.24 |
| Max. Negotiated Rate |
$272.69 |
| Rate for Payer: Aetna Commercial |
$266.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$254.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$157.09
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$272.69
|
| Rate for Payer: Health EOS Commercial |
$263.80
|
| Rate for Payer: HFN Commercial |
$272.69
|
| Rate for Payer: Multiplan Commercial |
$237.12
|
| Rate for Payer: Preferred Network Access Commercial |
$272.69
|
| Rate for Payer: Quartz Beloit One Network |
$145.24
|
| Rate for Payer: Quartz Commercial |
$177.84
|
| Rate for Payer: WEA Trust Commercial |
$163.02
|
| Rate for Payer: WPS Commercial |
$219.54
|
|
|
JAK2 Exon 12 Mutations
|
Facility
|
OP
|
$285.00
|
|
| Hospital Charge Code |
2942930
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$82.99 |
| Max. Negotiated Rate |
$272.69 |
| Rate for Payer: Quartz Beloit One Network |
$145.24
|
| Rate for Payer: Aetna Commercial |
$266.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$254.90
|
| Rate for Payer: Aetna Managed Medicare |
$82.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$192.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$148.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$142.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$157.09
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$272.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$165.87
|
| Rate for Payer: Health EOS Commercial |
$263.80
|
| Rate for Payer: HFN Commercial |
$272.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$222.30
|
| Rate for Payer: Multiplan Commercial |
$237.12
|
| Rate for Payer: NAPHCARE Commercial |
$177.84
|
| Rate for Payer: Preferred Network Access Commercial |
$272.69
|
| Rate for Payer: Quartz Commercial |
$192.66
|
| Rate for Payer: Quartz Medicare Advantage |
$177.84
|
| Rate for Payer: The Alliance Commercial |
$148.20
|
| Rate for Payer: United Healthcare PPO |
$222.30
|
| Rate for Payer: WEA Trust Commercial |
$163.02
|
| Rate for Payer: WPS Commercial |
$219.54
|
|
|
JAK2 Exon 12 Mutations
|
Professional
|
Both
|
$285.00
|
|
| Hospital Charge Code |
2942930
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$130.42 |
| Max. Negotiated Rate |
$281.58 |
| Rate for Payer: Aetna Commercial |
$281.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$254.90
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$281.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$148.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$177.84
|
| Rate for Payer: Health EOS Commercial |
$269.72
|
| Rate for Payer: HFN Commercial |
$281.58
|
| Rate for Payer: Multiplan Commercial |
$237.12
|
| Rate for Payer: Preferred Network Access Commercial |
$281.58
|
| Rate for Payer: Quartz Beloit One Network |
$130.42
|
| Rate for Payer: Quartz Commercial |
$168.95
|
| Rate for Payer: The Alliance Commercial |
$148.20
|
| Rate for Payer: WEA Trust Commercial |
$163.02
|
| Rate for Payer: WPS Commercial |
$219.54
|
|
|
Jak2 Interp & Report
|
Facility
|
OP
|
$60.00
|
|
| Hospital Charge Code |
2776830
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.47 |
| Max. Negotiated Rate |
$57.41 |
| Rate for Payer: Aetna Commercial |
$56.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$53.66
|
| Rate for Payer: Aetna Managed Medicare |
$17.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$40.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.07
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$57.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34.92
|
| Rate for Payer: Health EOS Commercial |
$55.54
|
| Rate for Payer: HFN Commercial |
$57.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.80
|
| Rate for Payer: Multiplan Commercial |
$49.92
|
| Rate for Payer: NAPHCARE Commercial |
$37.44
|
| Rate for Payer: Preferred Network Access Commercial |
$57.41
|
| Rate for Payer: Quartz Beloit One Network |
$30.58
|
| Rate for Payer: Quartz Commercial |
$40.56
|
| Rate for Payer: Quartz Medicare Advantage |
$37.44
|
| Rate for Payer: The Alliance Commercial |
$31.20
|
| Rate for Payer: United Healthcare PPO |
$46.80
|
| Rate for Payer: WEA Trust Commercial |
$34.32
|
| Rate for Payer: WPS Commercial |
$46.22
|
|
|
Jak2 Interp & Report
|
Professional
|
Both
|
$60.00
|
|
| Hospital Charge Code |
2776830
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.46 |
| Max. Negotiated Rate |
$59.28 |
| Rate for Payer: Aetna Commercial |
$59.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$53.66
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$59.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$31.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$37.44
|
| Rate for Payer: Health EOS Commercial |
$56.78
|
| Rate for Payer: HFN Commercial |
$59.28
|
| Rate for Payer: Multiplan Commercial |
$49.92
|
| Rate for Payer: Preferred Network Access Commercial |
$59.28
|
| Rate for Payer: Quartz Beloit One Network |
$27.46
|
| Rate for Payer: Quartz Commercial |
$35.57
|
| Rate for Payer: The Alliance Commercial |
$31.20
|
| Rate for Payer: WEA Trust Commercial |
$34.32
|
| Rate for Payer: WPS Commercial |
$46.22
|
|
|
Jak2 Interp & Report
|
Facility
|
IP
|
$60.00
|
|
| Hospital Charge Code |
2776830
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.58 |
| Max. Negotiated Rate |
$57.41 |
| Rate for Payer: Aetna Commercial |
$56.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$53.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.07
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$57.41
|
| Rate for Payer: Health EOS Commercial |
$55.54
|
| Rate for Payer: HFN Commercial |
$57.41
|
| Rate for Payer: Multiplan Commercial |
$49.92
|
| Rate for Payer: Preferred Network Access Commercial |
$57.41
|
| Rate for Payer: Quartz Beloit One Network |
$30.58
|
| Rate for Payer: Quartz Commercial |
$37.44
|
| Rate for Payer: WEA Trust Commercial |
$34.32
|
| Rate for Payer: WPS Commercial |
$46.22
|
|
|
Jak2 Separation
|
Facility
|
OP
|
$79.00
|
|
| Hospital Charge Code |
2776831
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$75.59 |
| Rate for Payer: Aetna Commercial |
$73.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$70.66
|
| Rate for Payer: Aetna Managed Medicare |
$23.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$53.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$41.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$39.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.54
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cigna Commercial |
$75.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$45.98
|
| Rate for Payer: Health EOS Commercial |
$73.12
|
| Rate for Payer: HFN Commercial |
$75.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$61.62
|
| Rate for Payer: Multiplan Commercial |
$65.73
|
| Rate for Payer: NAPHCARE Commercial |
$49.30
|
| Rate for Payer: Preferred Network Access Commercial |
$75.59
|
| Rate for Payer: Quartz Beloit One Network |
$40.26
|
| Rate for Payer: Quartz Commercial |
$53.40
|
| Rate for Payer: Quartz Medicare Advantage |
$49.30
|
| Rate for Payer: The Alliance Commercial |
$41.08
|
| Rate for Payer: United Healthcare PPO |
$61.62
|
| Rate for Payer: WEA Trust Commercial |
$45.19
|
| Rate for Payer: WPS Commercial |
$60.85
|
|
|
Jak2 Separation
|
Facility
|
IP
|
$79.00
|
|
| Hospital Charge Code |
2776831
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.26 |
| Max. Negotiated Rate |
$75.59 |
| Rate for Payer: Aetna Commercial |
$73.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$70.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.54
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cigna Commercial |
$75.59
|
| Rate for Payer: Health EOS Commercial |
$73.12
|
| Rate for Payer: HFN Commercial |
$75.59
|
| Rate for Payer: Multiplan Commercial |
$65.73
|
| Rate for Payer: Preferred Network Access Commercial |
$75.59
|
| Rate for Payer: Quartz Beloit One Network |
$40.26
|
| Rate for Payer: Quartz Commercial |
$49.30
|
| Rate for Payer: WEA Trust Commercial |
$45.19
|
| Rate for Payer: WPS Commercial |
$60.85
|
|
|
Jak2 Separation
|
Professional
|
Both
|
$79.00
|
|
| Hospital Charge Code |
2776831
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.15 |
| Max. Negotiated Rate |
$78.05 |
| Rate for Payer: Aetna Commercial |
$78.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$70.66
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cigna Commercial |
$78.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$41.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.30
|
| Rate for Payer: Health EOS Commercial |
$74.77
|
| Rate for Payer: HFN Commercial |
$78.05
|
| Rate for Payer: Multiplan Commercial |
$65.73
|
| Rate for Payer: Preferred Network Access Commercial |
$78.05
|
| Rate for Payer: Quartz Beloit One Network |
$36.15
|
| Rate for Payer: Quartz Commercial |
$46.83
|
| Rate for Payer: The Alliance Commercial |
$41.08
|
| Rate for Payer: WEA Trust Commercial |
$45.19
|
| Rate for Payer: WPS Commercial |
$60.85
|
|
|
JAK2 V617F Mutation, Quantitative
|
Professional
|
Both
|
$1,219.00
|
|
|
Service Code
|
CPT 81270
|
| Hospital Charge Code |
5313603
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$95.33 |
| Max. Negotiated Rate |
$1,204.37 |
| Rate for Payer: Aetna Commercial |
$1,204.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,090.27
|
| Rate for Payer: Aetna Managed Medicare |
$95.33
|
| Rate for Payer: Anthem Medicare Advantage |
$95.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$95.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$95.33
|
| Rate for Payer: Cash Price |
$365.70
|
| Rate for Payer: Cash Price |
$365.70
|
| Rate for Payer: Cigna Commercial |
$1,204.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$633.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$95.33
|
| Rate for Payer: Health EOS Commercial |
$1,153.66
|
| Rate for Payer: HFN Commercial |
$1,204.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$336.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$336.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$95.33
|
| Rate for Payer: Multiplan Commercial |
$1,014.21
|
| Rate for Payer: NAPHCARE Commercial |
$142.99
|
| Rate for Payer: Preferred Network Access Commercial |
$1,204.37
|
| Rate for Payer: Quartz Beloit One Network |
$557.81
|
| Rate for Payer: Quartz Commercial |
$722.62
|
| Rate for Payer: Quartz Medicare Advantage |
$95.33
|
| Rate for Payer: The Alliance Commercial |
$376.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$95.33
|
| Rate for Payer: WEA Trust Commercial |
$697.27
|
| Rate for Payer: WPS Commercial |
$419.44
|
|
|
JAK2 V617F Mutation, Quantitative
|
Facility
|
OP
|
$1,219.00
|
|
|
Service Code
|
CPT 81270
|
| Hospital Charge Code |
5313603
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$95.33 |
| Max. Negotiated Rate |
$1,166.34 |
| Rate for Payer: Aetna Commercial |
$1,140.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,090.27
|
| Rate for Payer: Aetna Managed Medicare |
$95.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$357.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$166.82
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$158.24
|
| Rate for Payer: Anthem Medicare Advantage |
$95.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$671.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$95.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$95.33
|
| Rate for Payer: Cash Price |
$365.70
|
| Rate for Payer: Cash Price |
$365.70
|
| Rate for Payer: Cigna Commercial |
$1,166.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$95.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$709.46
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$95.33
|
| Rate for Payer: Health EOS Commercial |
$1,128.31
|
| Rate for Payer: HFN Commercial |
$1,166.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$354.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$95.33
|
| Rate for Payer: Independent Care Health Plan Medicare |
$95.33
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$95.33
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$95.33
|
| Rate for Payer: Multiplan Commercial |
$1,014.21
|
| Rate for Payer: NAPHCARE Commercial |
$142.99
|
| Rate for Payer: Preferred Network Access Commercial |
$1,166.34
|
| Rate for Payer: Quartz Beloit One Network |
$621.20
|
| Rate for Payer: Quartz Commercial |
$824.04
|
| Rate for Payer: Quartz Medicare Advantage |
$95.33
|
| Rate for Payer: The Alliance Commercial |
$381.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$95.33
|
| Rate for Payer: United Healthcare PPO |
$950.82
|
| Rate for Payer: WEA Trust Commercial |
$697.27
|
| Rate for Payer: Wellcare Medicare |
$95.33
|
| Rate for Payer: WPS Commercial |
$939.00
|
|
|
JAK2 V617F Mutation, Quantitative
|
Facility
|
IP
|
$1,219.00
|
|
|
Service Code
|
CPT 81270
|
| Hospital Charge Code |
5313603
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$621.20 |
| Max. Negotiated Rate |
$1,166.34 |
| Rate for Payer: Aetna Commercial |
$1,140.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,090.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$671.91
|
| Rate for Payer: Cash Price |
$365.70
|
| Rate for Payer: Cigna Commercial |
$1,166.34
|
| Rate for Payer: Health EOS Commercial |
$1,128.31
|
| Rate for Payer: HFN Commercial |
$1,166.34
|
| Rate for Payer: Multiplan Commercial |
$1,014.21
|
| Rate for Payer: Preferred Network Access Commercial |
$1,166.34
|
| Rate for Payer: Quartz Beloit One Network |
$621.20
|
| Rate for Payer: Quartz Commercial |
$760.66
|
| Rate for Payer: WEA Trust Commercial |
$697.27
|
| Rate for Payer: WPS Commercial |
$939.00
|
|
|
Januvia 1 mg Charge
|
Professional
|
Both
|
$218.00
|
|
|
Service Code
|
HCPCS J9043
|
| Hospital Charge Code |
2958864
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$99.76 |
| Max. Negotiated Rate |
$668.47 |
| Rate for Payer: Aetna Commercial |
$215.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$194.98
|
| Rate for Payer: Aetna Managed Medicare |
$243.08
|
| Rate for Payer: Anthem Medicare Advantage |
$243.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$243.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$243.08
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cigna Commercial |
$215.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$240.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$220.23
|
| Rate for Payer: Health EOS Commercial |
$206.32
|
| Rate for Payer: HFN Commercial |
$215.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$279.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$279.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$243.08
|
| Rate for Payer: Multiplan Commercial |
$181.38
|
| Rate for Payer: NAPHCARE Commercial |
$364.62
|
| Rate for Payer: Preferred Network Access Commercial |
$215.38
|
| Rate for Payer: Quartz Beloit One Network |
$99.76
|
| Rate for Payer: Quartz Commercial |
$129.23
|
| Rate for Payer: Quartz Medicare Advantage |
$243.08
|
| Rate for Payer: The Alliance Commercial |
$668.47
|
| Rate for Payer: United Healthcare Medicaid |
$240.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$243.08
|
| Rate for Payer: WEA Trust Commercial |
$124.70
|
| Rate for Payer: WPS Commercial |
$550.56
|
|
|
Januvia 1 mg Charge
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
HCPCS J9043
|
| Hospital Charge Code |
2958864
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$111.09 |
| Max. Negotiated Rate |
$208.58 |
| Rate for Payer: Aetna Commercial |
$204.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$194.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$120.16
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cigna Commercial |
$208.58
|
| Rate for Payer: Health EOS Commercial |
$201.78
|
| Rate for Payer: HFN Commercial |
$208.58
|
| Rate for Payer: Multiplan Commercial |
$181.38
|
| Rate for Payer: Preferred Network Access Commercial |
$208.58
|
| Rate for Payer: Quartz Beloit One Network |
$111.09
|
| Rate for Payer: Quartz Commercial |
$136.03
|
| Rate for Payer: WEA Trust Commercial |
$124.70
|
| Rate for Payer: WPS Commercial |
$167.93
|
|
|
Januvia 1 mg Charge
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
HCPCS J9043
|
| Hospital Charge Code |
2958864
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$108.83 |
| Max. Negotiated Rate |
$972.32 |
| Rate for Payer: Aetna Commercial |
$204.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$194.98
|
| Rate for Payer: Aetna Managed Medicare |
$243.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$147.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$113.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$108.83
|
| Rate for Payer: Anthem Medicare Advantage |
$243.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$120.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$243.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$243.08
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cigna Commercial |
$208.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$243.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$291.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$243.08
|
| Rate for Payer: Health EOS Commercial |
$201.78
|
| Rate for Payer: HFN Commercial |
$208.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$904.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$243.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$243.08
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$243.08
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$243.08
|
| Rate for Payer: Multiplan Commercial |
$181.38
|
| Rate for Payer: NAPHCARE Commercial |
$364.62
|
| Rate for Payer: Preferred Network Access Commercial |
$208.58
|
| Rate for Payer: Quartz Beloit One Network |
$111.09
|
| Rate for Payer: Quartz Commercial |
$147.37
|
| Rate for Payer: Quartz Medicare Advantage |
$243.08
|
| Rate for Payer: The Alliance Commercial |
$972.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$243.08
|
| Rate for Payer: WEA Trust Commercial |
$124.70
|
| Rate for Payer: Wellcare Medicare |
$243.08
|
| Rate for Payer: WPS Commercial |
$550.56
|
|
|
Jaundice evaluation with lab ordered - Outpatient Newborn Follow-Up Charges
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
5356649
|
|
Hospital Revenue Code
|
514
|
| Min. Negotiated Rate |
$98.86 |
| Max. Negotiated Rate |
$185.62 |
| Rate for Payer: Aetna Commercial |
$181.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$173.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$106.93
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cigna Commercial |
$185.62
|
| Rate for Payer: Health EOS Commercial |
$179.57
|
| Rate for Payer: HFN Commercial |
$185.62
|
| Rate for Payer: Multiplan Commercial |
$161.41
|
| Rate for Payer: Preferred Network Access Commercial |
$185.62
|
| Rate for Payer: Quartz Beloit One Network |
$98.86
|
| Rate for Payer: Quartz Commercial |
$121.06
|
| Rate for Payer: WEA Trust Commercial |
$110.97
|
| Rate for Payer: WPS Commercial |
$149.44
|
|
|
Jaundice evaluation with lab ordered - Outpatient Newborn Follow-Up Charges
|
Facility
|
OP
|
$194.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
5356649
|
|
Hospital Revenue Code
|
514
|
| Min. Negotiated Rate |
$30.74 |
| Max. Negotiated Rate |
$185.62 |
| Rate for Payer: Aetna Commercial |
$181.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$173.51
|
| Rate for Payer: Aetna Managed Medicare |
$56.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$131.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$100.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$96.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$106.93
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cigna Commercial |
$185.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$112.91
|
| Rate for Payer: Health EOS Commercial |
$179.57
|
| Rate for Payer: HFN Commercial |
$185.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$151.32
|
| Rate for Payer: Multiplan Commercial |
$161.41
|
| Rate for Payer: NAPHCARE Commercial |
$121.06
|
| Rate for Payer: Preferred Network Access Commercial |
$185.62
|
| Rate for Payer: Quartz Beloit One Network |
$98.86
|
| Rate for Payer: Quartz Commercial |
$131.14
|
| Rate for Payer: Quartz Medicare Advantage |
$121.06
|
| Rate for Payer: The Alliance Commercial |
$30.74
|
| Rate for Payer: WEA Trust Commercial |
$110.97
|
| Rate for Payer: WPS Commercial |
$149.44
|
|
|
JAW BRA FACIAL SUPPORT 91
|
Facility
|
OP
|
$480.00
|
|
| Hospital Charge Code |
2963738
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$139.78 |
| Max. Negotiated Rate |
$459.26 |
| Rate for Payer: WPS Commercial |
$369.74
|
| Rate for Payer: Aetna Commercial |
$449.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$429.31
|
| Rate for Payer: Aetna Managed Medicare |
$139.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$324.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$249.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$239.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$264.58
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$459.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$279.36
|
| Rate for Payer: Health EOS Commercial |
$444.29
|
| Rate for Payer: HFN Commercial |
$459.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$374.40
|
| Rate for Payer: Multiplan Commercial |
$399.36
|
| Rate for Payer: NAPHCARE Commercial |
$299.52
|
| Rate for Payer: Preferred Network Access Commercial |
$459.26
|
| Rate for Payer: Quartz Beloit One Network |
$244.61
|
| Rate for Payer: Quartz Commercial |
$324.48
|
| Rate for Payer: Quartz Medicare Advantage |
$299.52
|
| Rate for Payer: The Alliance Commercial |
$249.60
|
| Rate for Payer: WEA Trust Commercial |
$274.56
|
|
|
JAW BRA FACIAL SUPPORT 91
|
Facility
|
IP
|
$480.00
|
|
| Hospital Charge Code |
2963738
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$244.61 |
| Max. Negotiated Rate |
$459.26 |
| Rate for Payer: Aetna Commercial |
$449.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$429.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$264.58
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$459.26
|
| Rate for Payer: Health EOS Commercial |
$444.29
|
| Rate for Payer: HFN Commercial |
$459.26
|
| Rate for Payer: Multiplan Commercial |
$399.36
|
| Rate for Payer: Preferred Network Access Commercial |
$459.26
|
| Rate for Payer: Quartz Beloit One Network |
$244.61
|
| Rate for Payer: Quartz Commercial |
$299.52
|
| Rate for Payer: WEA Trust Commercial |
$274.56
|
| Rate for Payer: WPS Commercial |
$369.74
|
|
|
JAW SUBLUXATION
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960395
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$292.95 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Aetna Managed Medicare |
$292.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$680.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$523.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$502.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$585.49
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.68
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: NAPHCARE Commercial |
$627.74
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$680.06
|
| Rate for Payer: Quartz Medicare Advantage |
$627.74
|
| Rate for Payer: The Alliance Commercial |
$523.12
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
JAW SUBLUXATION
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960395
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$512.66 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$627.74
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
